NRC Form 4, Cumulative Occupational Dose History

OMB 3150-0005

OMB 3150-0005

The NRC Form 4 is used to record the summary of an occupational worker’s cumulative occupational radiation dose, including prior occupational exposure and the current year’s occupational radiation exposure. The NRC Form 4 is used by licensees, and inspected by the NRC, to ensure that occupational radiation doses do not exceed the regulatory limits specified in 10 CFR 20.1501.

The latest form for NRC Form 4, Cumulative Occupational Dose History expires 2023-11-30 and can be found here.

All Historical Document Collections
Extension without change of a currently approved collection 2023-11-21
Approved without change
Extension without change of a currently approved collection 2020-07-28
Approved without change
Revision of a currently approved collection 2017-07-21
Approved without change
Revision of a currently approved collection 2014-03-27
Withdrawn and continue
Revision of a currently approved collection 2014-03-18
Approved without change
Revision of a currently approved collection 2010-10-28
Approved with change
No material or nonsubstantive change to a currently approved collection 2009-03-04
Approved without change
Revision of a currently approved collection 2007-11-28
Approved without change
Revision of a currently approved collection 2007-08-15
Preapproved
Revision of a currently approved collection 2006-12-05
Approved without change
Revision of a currently approved collection 2004-08-13
Approved without change
Revision of a currently approved collection 2001-07-30
Approved without change
Revision of a currently approved collection 1998-07-15
Approved with change
No material or nonsubstantive change to a currently approved collection 1998-04-21
Approved without change
Revision of a currently approved collection 1995-06-23
Approved without change
Revision of a currently approved collection 1992-07-16
Approved without change
Reinstatement with change of a previously approved collection 1991-06-26
Approved without change
Revision of a currently approved collection 1989-06-01
Approved without change
Reinstatement with change of a previously approved collection 1986-05-07
Approved without change
Revision of a currently approved collection 1985-12-12
Withdrawn and continue
Revision of a currently approved collection 1985-09-16
Approved without change
Revision of a currently approved collection 1983-04-08
Approved without change
Revision of a currently approved collection 1981-04-01

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